Abstract 14704: Sudden Cardiac Arrest Subjects Presenting with Shockable versus Non-Shockable Rhythms are not Distinguishable on Detailed Autopsy
Introduction: Sudden cardiac arrest (SCA) presenting with pulseless electrical activity (PEA) or asystole have a significantly higher mortality than ventricular fibrillation/tachycardia (VF/VT). We hypothesized that divergent etiologies would be identified during detailed post-mortem examination.
Methods: Cases of out-of-hospital SCA (age ≥18 years) with detailed autopsy were identified from an ongoing population-based study in Northwest US. SCA cases are enrolled in the study after review of available medical records and circumstance of arrest followed by a process of in-house adjudication. Autopsy findings were evaluated by type of presenting arrhythmia: VF/VT, PEA and asystole. Pearson’s x2tests and analysis of variance were used for univariate comparisons.
Results: From a total of 1695 SCA cases enrolled 2002-2012 there were 188 (11%) cases with detailed autopsy (mean age 46±12 years, 78% male). VF/VT was the presenting arrhythmia in 51%, PEA in 14% and asystole in 35% of cases. Patients with the three presenting arrhythmias were similar in age, arrest location, bystander CPR and response time (p≥0.12). VF/VT cases were more likely to be male and have a witnessed arrest (p<0.0001). Coronary artery disease (≥50% stenosis) was present in 68% of cases with no difference between presenting arrhythmias (p=0.50). Similarly, there were no significant differences by presenting arrhythmia in presence of fresh (overall present in 22%, p=0.61) or old myocardial infarction (overall present in 25%, p=0.38). Hypertrophic cardiomyopathy was present in 8% of VF/VT, 4% of PEA and 3% of asystole (p=0.33). There was no difference in presence of LV hypertrophy (p=0.41).
Conclusion: In sudden deaths with a cardiac etiology, mechanisms of manifestation with shockable vs. non-shockable rhythms will require further detailed investigation.
- © 2012 by American Heart Association, Inc.